The Effect of Melatonin on Morphological Changes of Rat Skeletal Muscle after Ischemia-Reperfusion Injury

The effect of melatonin on morphological changes after ischemia-reperfusion injury was investigated in rat skeletal muscle. Dimethyl-sulfoxide(DMSO) was also tested for comparison. Muscle injury was evaluated in 4 groups as a single laparotomy group(control), ischemia-reperfusion group, DMSO group, melatonin group. Left hind limb ischemia was induced for 4 hours by vascular clamping of the common femoral artery and followed by 24 hours of reperfusion. The midportion of gastrocnemius muscle was taken for histological evaluation. In light microscopic study, ischemia-reperfusion group showed severe neutrophil infiltration, interstitial edema, and partial loss or degeneration of muscle fibers. The muscle tissue of melatonin group showed relatively normal architecture with mild inflammatory cell infiltration. In electron microscopic study, dilated cisternae of sarcoplasmic reticulum, dilated mitochondria with electron loose matrix and dilated cristae, disordered or loss of myofilament, indistinct A-band and I-band, intracytoplasmic vacuoles, and markedly decreased glycogen granules were observed in ischemia-reperfusion group. But relatively well maintained A-band, I-band, Z-line, M-line, and mildly dilated mitochondria with well preserved cristae were observed in melatonin group. The DMSO group showed intermediately attenuated ultrastructural changes. The results show that melatonin improves morphologically ischemia-reperfusion injury more effectively than DMSO. In conclusion, melatonin seems to be a promising agent that can salvage the skeletal muscle from severe ischemia-reperfusion injury.

Clinical Experience of Surgical Treatment of Basal Cell Carcinoma of the Finger in Young Woman

Basal cell carcinoma(BCC) is malignant epithelial neoplasm arising from either basal cells or pluripotential appendageal cells of the epidermis. BCC is the most common cutaneous malignancy, especially in sun-exposed sites, such as head and neck. But its occurrence on the finger is very rare. We experienced a case of BCC arising on the dorsal surface of the middle finger of a young woman. This case is not associated with any predisposing factors such as basal cell nevus syndrome, trauma, or preexistent dermatosis. Following surgical removal of the lesion, the defect was covered with full-thickness skin graft. The patient has presented no sign of relapse for 1 year of clinical follow-up. We report this rare case of BCC in terms of age and location.

A Case of Atypical Fibroxanthoma

Atypical fibroxanthoma(AFX) is a tumor that occurs as a solitary and ulcerative nodule on actinically damaged or radiation damaged skin of the head and neck in the elderly. AFX is a pleomorphic spindle cell neoplasm of the dermis, which is a clinically benign reactive lesion despite of apparently malignant histologic features. We report a case of AFX which developed on the nasal root area of a 23-year-old man. This case is very unusual in terms of site(less sun-damaged area), overlying skin feature(grossly normal skin) and age(too young). This tumor was completely removed with surgical excision and remained free of recurrence for a period of about 1 year follow-up.

The Effect of Melatonin on Biochemical Changes after Ischemia-Reperfusion Injury of Rat Skeletal Muscle

The ischemia-reperfusion injury of the skeletal muscles is caused by generation of reactive oxygen during ischemia and reperfusion. Melatonin or N-Acetyl- 5-methoxy- tryptamine is suggested to have antioxidant effects in several tissues. In present study, we examined the protective effect of melatonin in a rat hind limb ischemia-reperfusion injury. Dimethyl-sulfoxide(DMSO) was also tested for comparison. Ischemia was induced for 4 hours by vascular clamping and followed by 1 hour or 24 hours of reperfusion. Muscle injury was evaluated in 4 groups such as single laparotomy group(control), ischemia-reperfusion group, DMSO group, melatonin group. Eedema ratio and malondialdehyde(MDA) of muscle tissue and serum level of creatine kinase(CK), were measeured at the end of reperfusion. DMSO and melatonin group showed significant amelioration of edema and serum CK compared with ischemia-reperfusion group. The decreasing effect was more prominent in melatonin group. The muscle tissue MDA concentration is significantly lower in melatonin group than in ischemia-reperfusion group. The results show that melatonin prevents and improves ischemia-reperfusion injury more effectively in a rat hind limb than DMSO dose. Thus, clinically the melatonin may be used for a beneficial treatment of such injuries.

Clinical Experience of Minimal Incision Rhytidectomy with Lateral SMASectomy

To overcome the facial aging, various facial rejuvenation techniques have been presented but each of them has some shortcomings respectively. Extended SMAS technique is not easy to apply and has high risk of facial nerve injury. Moreover, Orientals have some anatomical characteristics different from Caucasians; thicker facial skin, more conspicuous postoperative scar and less cervical deformity such as gobbler neck deformity. Considering these facts, we performed minimal incision rhytidectomy with lateral SMASectomy in 25 patients with aging faces. Based on our experiences, this technique is considered as an easy and quick method with minimal postoperative scar and no risk of facial nerve injury. And lateral SMASectomy is excellent for the correction of deep nasolabial fold, jowl and saggy jaw line. As a result, minimal incision rhytidectomy with lateral SMASectomy is suitable and recommendable facial rejuvenation for Koreans.

Easy Method to Determine Skin Excision Amount in Upper Blepharoplasty

The aging change that occur to the upper eyelid is the obscurity of the position of eyelid crease by the appearance of redundant upper eyelid skin and fold displacement. The solution is to raise the eyelid crease of the affected upper eyelid through the excision of excess soft tissue. Despite of many descriptions of blepharoplasty in the literature, marking the upper lid skin excision has not been well described. Many operators advocate use of a forceps to measure the amount of skin to be excised. But this method is not accurate and may result asymmetric double folds especially in less- experienced operators. Thus we present easy, accurate, and simple method to determine the amount of the skin to be excised as follows: The lower incision is drawn 6-8mm apart from the lid margin in sitting position while gently pulling upward the upper eyelid. While the marking pen is held at the level of the lower incision line, upper lid return to initial natural position, then a mark is made at the same level. After this procedure is repeated at several points, the dots are connected to a continuous line for the upper line of skin excision.

Management of Maxillary or Mandibular Fractures with Model Surgery and Occlusal Splint

Maxillary and mandibular fractures account for a large proportion of facial bone fractures. The primary objective in reduction of marillary or mandibular fractures is to return the structures to normal position of function and cosmetic contour, i.e. restoration of normal occlusal relations through proper positioning of the teeth and bony structures. Interdental wiring, intermaxillary fixation, rigid internal fixation or external pin fixation are common methods in the management of jaw fractures, varying with the age of the patient, location or extent of fracture. Malocclusion is not an uncommon complication after management of jaw pacture. We managed 16 patients (13 males, 3 females) of mandibular or maxillary fractures with model surgery and occlusal splint from July 1998 to August 1999. The average age of patients was 27.4 years and the average follow-up period was 6 months. We achieved good occlusal relationship without malunion, nonunion, or loss of teeth. Acrylic occlusal splints are rigid, strong, easily adjusted and repaired, translucent, lightweight and tolerated well by the oral mucosa. It is useful in the maintenance of intermaxillary fixation and in maintaining continuity of the maxillary or mandibular dental arch, as well as providing precise dental alignment during healing. Splints are helpful in managing fractures of the symphysis, parasymphyseal region, body and alveolar ridges of the mandible, sagittal fractures of the hard palate, and severely comminuted mandible fractures.

Revision of Unfavorable Double Eyelid Operation by Repositioning of Preaponeurotic Fat

Oriental blepharoplasty or the commonly called "double eyelid" operation is the most common cosmetic procedure among Orientals because the Orientals tend to be conscious of the fold due to the influx of Caucasians and social westernimtion. Anatomically, the upper eyelids of the Orientals are considerably digerent from those of Caucasians, and nearly half of them have single eyelids. Considering the anatomic characteristics of the Koreans, an appropriate design and operative technique must be selected carefully to obtain an aesthetically satisfactory result. However, the incidence of complications occurs frequently. Patients who are faced with unsatisfactory results are perplexed by the fact that such a commonly performed procedures yield such a high dissatisfaction rate, and that secondary revisions can not be easily done. An unfavorable result does not necessarily imply a postoperative complication. Equally important is the unsatisfaction of the patient, whose goal may not be based on good aesthetic principles. The most common source of dissatisfaction in patients who underwent double eyelid operation is postoperative asymmetry and high level of the lid fold. During the eight years from 1991 to 1997, a total 72 patients underwent the secondary blepharoplasty either by transversely slitting and removing multilaminated septal structures exposed to the previous operative scar and or by spreading the preaponeurotic fat, that was extruded into a thin layer. The average age of the patients was 26.5 years and average follow up period was 2 years. No remarkable complications were encountered after operarion by our method and desired aesthetic improvements were acquired in the majority of the patients.

Management of Fournier's Gangrene with PGE1 and Bilateral Superomedial Thigh Flap

Fournier's gangrene is an infective necrotizing fasciitis of the perineal, genital or perianal regions. Management of this disease has involved prompt surgical debridement with initiation of broad spectrum antibiotics and intensive supportive care. Multiple debridements orchiectomy, urinary deversion, and fecal diversion should be performed as clinically indicated. Hyperbaric oxygen therapy and topical application of unprocessed honey may prove to be useful adjuncts as new therapies. After excision of all necrotic tissue, the tissue losses have been managed by primary repair. split-thickness skin grafts, rotational or free myocutaneous flaps and omental flaps. Skin graft did not take on bare testis lacking the tunica vaginalis, and gracilis myocutanous flap was too bulky to cover the scrotal area. The progress of necrosis ceased by using intravenous PGE1 injection in the aspect of characteristic obliterative endarteritis causing cutaneous and subcutaneous vascular thrombosis and necrosis of tissue in Fournier's gangrene. We have reconstructed large scrotal defects with bilateral superomedial thigh flap in three Fournier's gangrene patients after stopping tissue necrosis with PEG1 treatment and several surgical debridements of the wounds. The use of this flap ensures a virtually normal sensation, which is important for the erotic propensity of the scrotum. Easy flap design and dissection, as well as primary closure of the donor site, are another benefits of this method.